Contractor Questionnaire

Company Information

Company Name:

Training/Qualification

Plastic CertificationMechanical CertificationSteel Pipe Welding CertificationRelightsFederal D.O.T.None

Insurance Information

Insurance Carrier:

Public Liability Limits:

(Maximum)

Workmen’s Compensation Modification Rate:

Desired Geographic Location*

NYPANY & PA

*required

Type of Work Desired:

Please select no more than two

Plastic Pipeline ConstructionEnvironmental ConsultantsSteel Pipeline ConstructionRight-of-Way Clearing & MaintenancePipeline Locating ServicesIntegrity Management ServicesLeak Survey ContractorsStorage Field Engineering and ConsultingPipeline Corrosion ServicesStorage Well Construction ServicesPipeline WeldersPipeline Painting ContractorsCompressor Station ConstructionProperty Restoration ContractorCompressor Station Engineering and DesignDirectional Drilling ContractorsAircraft Pipeline Patrol Service (Helicopter, Fixed-Wing)Other

Work Experience

Five (5) major projects completes – Owner, Type of Work, Dollar Value, Year

Owner:

Type of Work:

Owner:

Type of Work:

Owner:

Type of Work:

Owner:

Type of Work:

Owner:

Type of Work:

References

Provide at least one

Company Name:

Company Name:

Company Name:

Δ